This invention relates to techniques for accommodating fluidic tube apparatus, such as drainage apparatus, often required for patients following a thoracic medical procedure such as surgery, e.g., a mastectomy, axillary node dissection, plastic surgery, or a procedure such as chemotherapy, or other thoracic procedure. Many medical thoracic procedures, and in particular surgical procedures that require the removal of tissue, e.g., in a mastectomy or axillary node dissection, are traumatic to the human body. The removal of a large amount of tissue in such a procedure tends to create in the body a cavity in which fluid collects. To prevent swelling and infection that could result from fluid remaining in the body, it is common practice to insert a drainage tube into the cavity at a point along the incision. This drainage tube, which is typically perforated at both ends and is often several inches long, extends to a collection receptacle, e.g., a plastic bulb, for collection of fluid drained by the tube. The suction created by the drainage tube is understood to aid in binding the skin of the cavity to the muscle until the incision heals.
The number of drainage tubes and collection receptacles required can vary from as few as one to as many as six, depending on the type of medical procedure and the amount of fluid expected to be produced by the body. The time required for drainage of the produced fluid can be as short as one week or as long as several weeks after the medical procedure. Historically, individuals undergoing such a medical procedure remained hospitalized until the drainage tubes were no longer required. But with the advent of managed medical care, hospitals frequently discharge patients on the same day or one to two days following a procedure such as surgery. Once a patient has received instruction on how to attend to the drainage apparatus; i.e., how to empty the collection receptacles, measure collected fluid, and keep a written record for the physician, the patient is discharged to self-care.
Outside the hospital setting, the patient is left to figure out how to adapt to life with the often painful, annoying, and cumbersome appendages of the drainage apparatus. However many drainage tubes and collection receptacles are employed, and for however long they are required, the management of the tubes and collection receptacles pose numerous and varied problems for the patient. Specifically, the tubes and receptacles can be a constant source of aggravation to the patient in that they restrict mobility, are cumbersome to wear, and must be monitored and emptied frequently, thus requiring ready and easy access. Furthermore, because of the bulk of the drainage apparatus, and the discomfort at the incision site, conventional clothing often cannot be worn.
To enable support of drainage apparatus at a location adjacent to the patient""s body, various methods and devices have been historically employed and proposed. In one common technique, the collection receptacle is pinned to the gown worn by the patient or to the bandage covering the incision. This method, while not very comfortable, is effective in the hospital when an open gown is often worn. However, this approach causes the patient to be more dependent on assistance in manipulating the pin while holding the drainage receptacle in place during the pinning. This approach has the further disadvantage of the sharp end of the pin possibly becoming unhooked and pricking the patient, causing additional pain and discomfort. Moreover, outside the hospital, where conventional, yet constricting, clothing is worn, use of such means to support collection receptacles and drains is awkward and impractical due to their bulk and inaccessibility for maintenance.
In another common technique, the drainage tubes and collection receptacles are taped directly to the torso of the individual. But because the drainage tubes must be repeatedly untaped and retaped to empty the collection receptacle, the tape often loses its adhesiveness. Consequently, when the drainage tubes are in use, the tape can come undone at an inopportune time, causing the weight of the fluid in the collection receptacles to pull on the tubes, inflicting pain. Also, because the drainage tubes are taped to the body, which is usually covered by some form of clothing, they are not easily and readily accessible for maintenance purposes. The awkwardness, discomfort, and impracticality of these common approaches are only compounded when multiple sets of tubes and receptacles are required to be worn by the patient.
Other proposed approaches for supporting medical drainage apparatus have required various features that frequently are impractical. For example, in U.S. Pat. No. 5,716,344 there is proposed the use of a belt secured around the torso for supporting a drainage receptacle. The receptacle is supplied with a plastic loop through which the belt can be inserted for supplying support. Similarly, in U.S. Pat. No. 5,439,456, there is proposed the use of a band encircling a leg for supporting a drainage receptacle. Fasteners on the band connect to and hold the receptacle on the band. In U.S. Pat. No. 5,643,233, a pouch, for carrying a drainage receptacle, is provided attached to a belt worn around the torso. In U.S. Pat. No. 5,980,499, a plurality of pockets are provided attached to a belt for carrying multiple drainage receptacles.
While these various devices do serve to support a drainage apparatus adjacent to the body, they do not assist in or enhance the patient""s adjustment to post-hospital life and self-care with drainage apparatus in-place. All of these proposed devices are required to be worn under clothing. But the bulkiness of the apparatus, the discomfort and swelling at the surgical site, and restriction of mobility are all accentuated when the drainage apparatus is worn under conventional clothing. The necessity of disrobing to access and maintain the drains increases the recovering patient""s discomfort and decreases the patient""s ability to function independently.
There have also been proposed various configurations of compression and other undergarments that accommodate drainage apparatus. For example, in U.S. Pat. No. 5,429,593, there is proposed a compression dressing having a cut out portion, at the lower edge of the dressing, through which drainage tubes can be supplied. A loop on the dressing above the aperture, high on the torso, is supplied for holding the drainage receptacle against the dressing. Although this configuration maintains the receptacle adjacent the body, its elevated placement of the receptacle can inhibit fluid flow from the incision site to the receptacle, increasing the risk of infection. Finally, in U.S. Pat. No. 5,257,956, there is proposed a compression vest having an aperture, under an arm location, through which drainage tubes can be supplied. No support of the drainage receptacle is supplied in this design. In addition, like the belt and band configurations described above, these configurations also suffer in that they both are undergarments.
It is thus found that the various techniques and configurations commonly employed for support of drainage and other fluidic apparatus fail to meet the needs of a patient convalescing out of the hospital. The drainage apparatus must be supported while at the same time permitting easy access for frequent maintenance of the collection receptacles. Heretofore, this has not been achievable in a configuration enabling conventional-style clothing that can be worn home from the hospital, while convalescing, and outside the home when attending medical appointments and doing errands.
The invention provides garments that can be worn as top clothes and that provide support and access to fluidic apparatus on the outside of the garments, while allowing for fashion, modesty, and discretion during a recovery process. The garments include a torso portion of an extent sufficient to encircle a garment wearer""s torso and arm openings provided in the torso portion. Generally vertical and cooperating front torso portion edges are included, providing a vertical front closure of the torso portion. At least one opening in the torso portion is provided. This garment opening is of an extent that is sufficient to accommodate passage of a fluidic tube and a corresponding fluidic receptacle through the opening. The garment opening extent is also sufficient to accommodate positioning of at least one fluidic tube to extend through the garment opening. At least one fluidic receptacle support is located on an outside surface of the torso portion. The fluidic receptacle support has a receptacle support surface which is vertically below a point at which a corresponding fluidic tube would be positioned to extend through a corresponding garment opening.
This garment configuration enables self-access, positioning, and maintenance of drainage tubes and receptacles by the garment wearer, and overcomes the limitations of prior drainage support techniques that failed to allow a recovering patient to have access to drainage apparatus while at the same time concealing the apparatus.
In embodiments provided by the invention, the garment opening is located at a position around the torso portion corresponding to location of a garment wearer""s incision at which the fluidic tube is initiated, and the garment opening is located on the torso portion below the garment wearer""s incision location. One or more garment opening fasteners can be provided at a point along the garment opening to close the opening around a fluidic tube positioned to extend through the opening. The garment opening fastener can be provided along the garment opening to substantially fully close the opening. One or more fluidic tube fasteners can be located on the outside surface of the torso portion of the garment, provided with a tab to secure at least one fluidic tube to the torso portion. The fluidic tube fastener can be located at a point along the garment opening. The garment opening can be located at a point along a seam of the torso portion.
In embodiments provided by the invention, the garment opening is located at a position around the torso portion that is self-accessible by the garment wearer. Sleeve portions can be provided connected to the torso portion. The sleeve portions are preferably connected to the torso portion at a drop-shoulder sleeve opening. A kick pleat can be located at a back region of the torso portion. In further embodiments provided by the invention, a front yoke is provided having a gathering located above a point generally corresponding to the bust line of the garment wearer. The cooperating front torso portion edges can include one or more fasteners at the front closure of the torso portion. The cooperating front torso portion edges can be of sufficient horizontal extent to horizontally overlap at the front closure of the torso portion.
The fluidic receptacle support can be provided as, e.g., a compartment, pouch, sleeve, or pocket on an outside surface of the torso garment portion. Considering a support pocket, the pocket can be provided as a slanted pocket, including reinforced pocket seam stitching. The pocket can extend sufficiently over the torso portion outer surface to support and substantially conceal a fluidic receptacle or receptacles. One or more fluidic tube fasteners can be located in the support pocket, including a tab to secure at least one fluidic tube to the torso portion. Preferably, the pocket includes a pocket bottom that is located on the garment torso portion vertically below a point at which a corresponding fluidic would be positioned to extend through a corresponding garment opening. The support pocket can extend over the torso portion a distance sufficient to cover at least a portion, or substantially all of, the corresponding garment opening. The support pocket can further be configured to include a storage pocket on top of the support pocket, and can include an interior surface that is impervious to fluid.
The garments of the invention are particularly well suited for use by female patients who have undergone thoracic surgery such as, e.g., chest, breast, or underarm surgery. The garments are not, however, limited to such procedures. Indeed, the garments of the invention can be advantageously employed in conjunction with any medical procedure, thoracic or otherwise, that requires the support of a drainage apparatus attached to the body. Furthermore, the garments of the invention can be advantageously employed for supporting apparatus other than drainage apparatus, such as chemotherapy apparatus, e.g., for supporting a chemotherapy supply to a port attached to the body. It is therefore to be understood that the garments of the invention are applicable to a wide range of conditions and apparatus, and can easily be adapted for use by youths and male as well as female patients. Furthermore, the ability to convert the garment openings to conventional seams extends the functionality of the garment to the entire treatment and recovery period, and beyond.
Other applications, features, and advantages of the invention will be apparent from the following description and associated drawings, and from the claims.